10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis

Abstract

Medical treatment with antibiotic therapy remains the mainstay of treatment for pyogenic spondylodiscitis (PS). Nevertheless, orthopaedic treatment is also very important in relieving pain, preventing neurological damage, and avoiding development of spinal deformities (e.g., scoliosis, kyphosis) due to spinal instability. Rigid thoracolumbosacral orthosis (TLSO) bracing is often needed in patients with PS, and average duration of treatment of 3 to 4 months. However, TLSO bracing can be poorly tolerated and limit ability of the patient to go back to a normal life. In 2004 our group developed an alternative surgical treatment to TLSO bracing by percutaneous posterior screw-rod bridge instrumentation of the infected level. This treatment allows early and free mobilization of the patients and is associated with faster recovery, lower pain scores and improved quality of life as previously reported. Herein, we report the clinical outcome of the first 3 patients who have completed the 10 years follow-up mark after the procedure. A case report is also described and details of the procedure are provided.

Keywords: minimally-invasive spinal surgery; percutaneous posterior spinal stabilization; pyogenic spondylodiscitis; spinal infections; surgical treatment of pyogenic spondylodiscitis.

Figure 1

Pre- and post-treatment self-reported VAS scores for back pain (n = 3, 10 years follow-up) are shown at 1, 3, 6, 9, months, 2 years and 10 years after surgical treatment with percutaneous posterior fixation.

Figure 2

Pre- and post-treatment SF-12 physical and mental component scores (n = 3, 10 years follow-up) are shown at 1, 3, 6, 9, months, 2 years and 10 years after surgical treatment with percutaneous posterior fixation.

Figure 3

Pre- and post-treatment EQ-5D scores (n = 3, 10 years follow-up) are shown at 1, 3, 6, 9, months, 2 years and 10 years after surgical treatment with percutaneous posterior fixation.

Figure 4

Pre-operative, immediate post-operative and 10 years follow-up segmental kyphosis level.

Figure 5

Pre- and post-operative imaging of the case report detailed in the manuscript. Panels (A,B) show sagittal and axial CT scan imaging of the T11–T12 infected level. Panels (C,D) show comparison of standing AP X-ray imaging of the spine immediately after surgery and at 10 years follow-up. Instrumentation is noted with pedicle screws and rods. The instrumentation is bridging the infected level. Panels (E–G) show comparison of standing lateral view X-ray imaging of the spine immediately after surgery and at 10 years follow-up. No mobilization of the instrumentarion is noted, the infected level is completely fused and segmental kyphosis is preserved.